More than 500,000 infants are born prematurely annually and 50-70 percent have later impairments requiring specialized services. Costs associated with preterm birth in the U.S. were at least $26.2 billion in 2005. A recent Institute of Medicine report recommends long term outcome studies into young adulthood for preterm infants to determine the extent of recovery, if any, and to monitor them for the onset of disease. In this competing renewal, we respond to this recommendation and propose an eighth study at age 23 of a unique sample of 213 infants grouped by prematurity and perinatal morbidity with a full term control group. We have retained 92 percent of the sample since birth and 97 percent since age 12. We now propose to examine the impact of prematurity, medical history and environments on achievements and deficits during young adulthood. Raised by the Developmental Origins Theory, we will investigate whether the impact of prematurity on poor health and early disease onset could be explained by alteration in hypothalamic-pituitary-adrenal axis (HPA) function.
The specific aims are to: (1) Determine effects of prematurity and risk and protective processes on adult outcomes of health, functional performance, emotional intelligence, executive function, and work competence at age 23;(2) Determine the developmental trajectories for growth, neurological morbidities, and psychological problems from birth to age 23 and estimate the effects of cumulative risk and protective processes;(3) Examine the relationship of HPA function and prematurity and its impact on adult outcomes of cardiovascular function, functional performance, emotional intelligence, executive function, and work competence at age 23. Data will to be collected during home and laboratory visits using standardized questionnaires, interviews and objective performance based assessments. Biomarkers are integrated and include blood chemistry, pulmonary function testing, cardiopulmonary response to exercise and metabolic functioning, and HPA function by salivary cortisol. Our analysis approach will use mixed models which enable determination of whether the covariates predict outcome across time, if the relationship changes over time, and if within-subject changes in outcome are predicted by changes in a covariate. Given the state of the science, this prospective, 5-group longitudinal design will establish the extent of recovery from prematurity and the onset of disease during adulthood within a developmental framework characterized by risk and protection processes. When developmental trajectories from premature birth through early adulthood and factors that influence and impede them are understood, we will be better able to understand the etiology of long term outcomes to pinpoint the timing and content of preventative interventions. This project is designed to fulfill this goal. Formulating a science of prevention requires attention to complex interactions between infants and their contexts across periods of time. Thus, the project is closely aligned with the initiatives of Healthy People 2010, the IOM, and NINR.

Public Health Relevance

More than 525,000 infants are born prematurely annually and 50 percent-70 percent have later impairments requiring specialized services. Costs associated with preterm birth in the United States were at least $26.2 billion in 2005 and expected to rise as more preterm infants survive. Understanding trajectories from premature birth through adulthood, and the processes that affect them, will enable professionals to make early identification of those at risk to more accurately pinpoint the timing and content of intervention.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR003695-18
Application #
8298190
Study Section
Nursing Science: Children and Families Study Section (NSCF)
Program Officer
Hardy, Lynda R
Project Start
1994-09-25
Project End
2014-06-30
Budget Start
2012-07-01
Budget End
2014-06-30
Support Year
18
Fiscal Year
2012
Total Cost
$445,261
Indirect Cost
$35,375
Name
University of Rhode Island
Department
Type
Schools of Nursing
DUNS #
144017188
City
Kingston
State
RI
Country
United States
Zip Code
02881
Scott, Allie; Winchester, Suzy Barcelos; Sullivan, Mary C (2018) Trajectories of problem behaviors from 4 to 23 years in former preterm infants. Int J Behav Dev 42:237-247
Troutman, John A; Sullivan, Mary C; Carr, Gregory J et al. (2018) Development of growth equations from longitudinal studies of body weight and height in the full term and preterm neonate: From birth to four years postnatal age. Birth Defects Res 110:916-932
Winchester, Suzy B; Sullivan, Mary C; Roberts, Mary B et al. (2018) Long-Term Effects of Prematurity, Cumulative Medical Risk, and Proximal and Distal Social Forces on Individual Differences in Diurnal Cortisol at Young Adulthood. Biol Res Nurs 20:5-15
Sullivan, Mary C; Winchester, Suzy B; Bryce, Crystal I et al. (2017) Prematurity and perinatal adversity effects hypothalamic-pituitary-adrenal axis reactivity to social evaluative threat in adulthood. Dev Psychobiol 59:976-983
Roberts, Mary B; Sullivan, Mary C; Winchester, Suzy B (2017) Examining solutions to missing data in longitudinal nursing research. J Spec Pediatr Nurs 22:
Sharafi, Mastaneh; Duffy, Valerie B; Miller, Robin J et al. (2016) Dietary behaviors of adults born prematurely may explain future risk for cardiovascular disease. Appetite 99:157-167
Winchester, Suzy Barcelos; Sullivan, Mary C; Roberts, Mary B et al. (2016) Prematurity, Birth Weight, and Socioeconomic Status Are Linked to Atypical Diurnal Hypothalamic-Pituitary-Adrenal Axis Activity in Young Adults. Res Nurs Health 39:15-29
Sullivan, Mary C; Winchester, Suzy Barcelos; Parker, Jeffrey G et al. (2012) Characteristic Processes in Close Peer Friendships of Preterm Infants at Age 12. Scientifica (Cairo) 2012:
Sullivan, Mary C; Miller, Robin J; Msall, Michael E (2012) 17-year outcome of preterm infants with diverse neonatal morbidities: part 2, impact on activities and participation. J Spec Pediatr Nurs 17:275-87
Sullivan, Mary C; Msall, Michael E; Miller, Robin J (2012) 17-year outcome of preterm infants with diverse neonatal morbidities: Part 1--Impact on physical, neurological, and psychological health status. J Spec Pediatr Nurs 17:226-41

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